Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | D33440S | ID |
NPI | 1043323843 |
---|---|
Provider Name | Alan Royce Pearce |
First Address | Nampa, ID 83686-2856 |
Second Address | Nampa, ID 83686-2856 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U76736 | (02) |